Provider Demographics
NPI:1588337257
Name:JACOBS, MARIA VICTORIA BARTOLOME (DMD)
Entity type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:BARTOLOME
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:BARTOLOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARIA JACOBS, DMD
Mailing Address - Street 1:15731 BERNARDO HEIGHTS PKWAY
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:858-674-6813
Mailing Address - Fax:
Practice Address - Street 1:15731 BERNARDO HEIGHTS PKWAY
Practice Address - Street 2:STE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:858-674-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1067301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice